Abstract 4147118: Balloon-Expandable versus Self-Expandable Valve for the Management of Bicuspid Aortic Disease: An Updated Meta-Analysis of Clinical Outcomes

Background: Transcatheter aortic valve implantation (TAVI) has been employed in the management of aortic stenosis (AS) in patients with bicuspid aortic valve (BAV) disease. Nevertheless, the comparative clinical outcomes of different types of valves used in this procedure remain inconclusive. Therefore, we conducted an updated meta-analysis to evaluate the performance of balloon-expandable (BEV) vs self-expandable valves (SEV) in patients with BAV going through TAVI. Methods: We systematically searched PubMed, Embase and Cochrane for studies comparing BEV and SEV in the treatment of AS in patients with BAV undergoing TAVI. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the Cochran Q test and I 2 statistics. Statistical analysis was performed utilizing Review Manager 5.4.1. Results: We included 9 observational studies with a total of 1,666 patients, of whom 974 (58,46%) received a BEV. The follow-up duration ranged from 30 days to 2 years. The pooled analysis revealed no significant differences between the BEV and SEV groups in terms of procedural death (OR 1.05; 95% CI 0.29 – 3.74; P=0.94), 30-day all-cause mortality (OR 0.98; 95% CI 0.55 – 1.72; P=0.93; Figure 1A), 30-day cardiovascular mortality (OR 1.02; 95% CI 0.47 – 2.23; P=0.96), 1 year all-cause mortality (OR 1.06; 95% CI 0.58 – 1.93; P=0.86), annulus rupture (OR 2.67; 95% CI 0.53 – 13.59; P=0.24), coronary obstruction (OR 1.29; 95% CI 0.31 – 5.43; P=0.72), new pacemaker implant (OR 0.76; 95% CI 0.48 – 1.20; P=0.23), moderate or severe aortic regurgitation (OR 0.34; 95% CI 0.11 – 1.00; P=0.05) and stroke (OR 1.18; 95% CI 0.58 – 2.40; P=0.64). However, the requirement of a second valve was significantly less common in patients with BEV compared to those with SEV (OR 0.36; 95% CI 0.17 – 0.76; P<0.01; Figure 1B). Conclusions: This meta-analysis suggests that both types of valves exhibit similar clinical outcomes in patients with BAV undergoing TAVI. Nonetheless, BEV was associated with lower odds of requiring a second valve compared to SEV. Further randomized controlled trials are necessary to confirm these findings.